Urological Consultants of Floridahttps://urologist-miami.com
Miami's preeminent providers of urological care
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1 http://wordpress.com/https://s0.wp.com/i/buttonw-com.pngUrological Consultants of Floridahttps://urologist-miami.com
Enlarged Prostate Specialist Miamihttps://urologist-miami.com/2013/03/05/enlarged-prostate-specialist-miami/
https://urologist-miami.com/2013/03/05/enlarged-prostate-specialist-miami/#respondTue, 05 Mar 2013 01:54:20 +0000http://urologist-miami.com/?p=195Continue reading →]]>David Robbins, MD is a board certified urologist and specialist in the medical and surgical management of BPH or enlarged prostate. Dr. Robbins has extensive experience in the treatment of enlarged prostate conditions and urinary retention using the state of the art Green Light Laser XPS system. Using this technology Dr. Robbins is able to improve patients burdensome voiding symptoms including urinary urgency, frequency, night time frequency, incomplete emptying, slow stream and incontinence even for prostates that are considered by others to be too large for minimally invasive surgery. Using laser technology, without the need for a surgical incision, Dr. Robbins uses Green Light Laser technology to relieve prostate obstruction in under an hour without the need for an overnight hospital stay or prolonged catheterization. Unlike the traditional TURP procedure, Green Light Laser technology, in the capable hands of a renowned expert like Dr. David Robbins, does not result in blood loss and the need for a hospital stay and prolonged catheterization.

]]>https://urologist-miami.com/2013/03/05/enlarged-prostate-specialist-miami/feed/0drobbinsmdProstate Cancer Detectionhttps://urologist-miami.com/2012/09/23/prostate-cancer-detection-miami-urologist/
https://urologist-miami.com/2012/09/23/prostate-cancer-detection-miami-urologist/#respondSun, 23 Sep 2012 23:03:04 +0000http://urologist-miami.com/?p=192Continue reading →]]>“The article below was found on the medical x press blog online. It highlights research related to DNA methylation which may play a vital role in the development of more specific biomarkers used for earlier prostate cancer detection. In the era when the utility of the PSA test is continuously being questioned, the need for more sensitive and specific biomarkers is of paramount importance. Miami urologists David Robbins, MD and Amery Wirtshafter, MD are experts in the field of prostate cancer detection and treatment and employ the most up to date modalities in the fight against prostate cancer.” David Robbins , MD.

Researchers discover biomarkers for prostate cancer detection, recurrence May 14, 2012 in Cancer Alterations to the “on-off” switches of genes occur early in the development of prostate cancer and could be used as biomarkers to detect the disease months or even years earlier than current approaches, a Mayo Clinic study has found. These biomarkers — known as DNA methylation profiles — also can predict if the cancer is going to recur and if that recurrence will remain localized to the prostate or, instead, spread to other organs. The study, published in the journal Clinical Cancer Research, is the first to capture the methylation changes that occur across the entire human genome in prostate cancer. Ads by Google Prostate Cancer Failures – Hope for treatment failures/ Rising PSA after treatment – http://www.panamhifu.com Cancer Treatment Options – Diagnosed w/Adenocarcinoma? Learn About New Treatment Options at CTCA – http://www.CancerCenter.com The discovery could someday help physicians diagnose prostate cancer earlier and make more effective treatment decisions to improve cure rates and reduce deaths. It also points to the development of new drugs that reverse the DNA methylation changes, turning the “off” switch back “on” and returning the genetic code to its normal, noncancerous state. “Our approach is more accurate and reliable than the widely used PSA (prostate-specific antigen) test,” says senior author Krishna Donkena, Ph.D., a Mayo Clinic molecular biologist. The PSA test detects any prostate abnormality, whether inflammation, cancer, infection or enlargement, while the DNA methylation changes are specific to prostate cancer, she says. Though the instructions for all the cell’s activities lie within the genes, whether a particular gene is turned “off” or “on” is determined by the presence or absence of specific chemical tags or methyl groups — methylation — along the underlying DNA of cells. When this process of DNA methylation turns off the activity of tumor suppressor genes, cancer develops. Dr. Donkena and her colleagues analyzed the methylation status of 14,495 genes from 238 prostate cancer patients. The patients included people who remained cancer-free after treatment, those who had a localized tumor recurrence and those whose cancer spread. The researchers found that the DNA methylation changes that occurred during the earliest stages of prostate cancer development were nearly identical in all patients. Having discovered DNA methylation patterns that could distinguish between healthy and cancerous tissue, the researchers then searched for similar biomarkers that could distinguish between patients with varying levels of recurrence risk. They found distinct methylation alterations that corresponded to whether a patient had a slow-growing tumor known as an indolent tumor, or had a more aggressive one. If physicians can determine what type of tumor patients have, they can avoid exposing patients with indolent tumors to unnecessary treatment, and can treat those with aggressive tumors earlier and more effectively, Dr. Donkena says. Dr. Donkena and her colleagues are working to develop a DNA methylation test that is more cost-effective and practical for use in clinical settings. Currently, the test relies on microarray or gene “chip” technology that assesses methylation status of genes across an entire genome. The researchers are trying to generate more economical custom microarray to specifically look at only the genes that predict the development of prostate cancer or recurrence. They also hope to develop drugs that can reverse DNA methylation in prostate cancer cells. Similar drugs are already being used to treat certain forms of leukemia. Journal reference: Clinical Cancer Research Provided by Mayo Clinic

]]>https://urologist-miami.com/2012/09/23/prostate-cancer-detection-miami-urologist/feed/0drobbinsmdDiabetic Sues Doctor After His Infected Penis Is Amputatedhttps://urologist-miami.com/2012/05/26/infected-penile-implant/
https://urologist-miami.com/2012/05/26/infected-penile-implant/#respondSat, 26 May 2012 06:41:17 +0000http://urologist-miami.com/?p=185Continue reading →]]>“An infection after placement of a penile implant is a potentially dangerous problem. The article below published on ABC news highlights the issues surrounding the controversial case of a Miami urologist who placed a penile prosthesis in a diabetic patient which resulted in a severe infection necessitating penile amputation. Fortunately, infections after placement of penile implants are rare complications. The penile implants that I place manufactured by AMS are antibiotic coated and have an infection rate of less than 1%. Although having diabetes is certainly not a contraindication to placement of a penile implant, certainly having poorly controlled diabetes increases a patient’s risk for developing an infection. For this reason, it is important for urologists to pay attention to a patients diabetes control and evaluate the hemoglobin A1c which is an indicator of the patients diabetes control over the past several months. In my practice, if a patient has refractory erectile dysfunction and is interested in a penile implant, but his hemoglobin A1c is elevated, I defer placement of the penile prosthesis until the patient in combination with his primary care physician or endocrinologist is able to improve his patients diabetes control and bring the hemoglobin A1c back down to normal levels. Unfortunately, even under optimal conditions, an infection can occur. The most important factor in the context of an infection of a penile prosthesis is early recognition and intervention to prevent severe complications such as a penile amputation as highlighted in the article below. “

Diabetic Sues Doctor After His Infected Penis Is Amputated

A man who elected to have a penile implant in a Florida hospital is now suing his doctor after a post-surgical infection resulted in the amputation of his organ.

Enrique Milla, 65, who was reportedly deported from the United States last year back to his native Peru, has been testifying in court via Skype that the medical procedure robbed him of his dignity and manhood.

In a medical malpractice trial that began this week, Milla claims that his doctors should have known that he was not a good candidate for the procedure because of his diabetes and high blood pressure.

“This has been devastating, painful and embarrassing,” said Milla’s attorney, Spencer Aronfeld of Coral Gables, according to ABC’s affiliate WPLG.

Milla alleges that his anesthesiologist Dr. Laurentiu Boeru “failed to evaluate properly the risks of this procedure.” He first filed the lawsuit in 2009, naming Boeru and Dr. Paul Perito, the urologist who performed the surgery.

According to the Miami Herald, which obtained records that are not publicly available, Perito settled the case out of court.

“At the end of the day, he has to sit down to pee through a tube,” Aronfeld told the Herald.

Penile implant surgery is most commonly performed after all other treatments for erectile dysfunction have failed. It is also used to treat some cases of Peyronie’s disease, a condition that causes scarring inside the penis, leading to bent, painful erections.

Implant surgery comes with a risk of infection, which can occur at any time after surgery — in rare cases, even years later, according to the Mayo Clinic.

Milla suffered from a number of medical conditions, including erectile dysfunction, according to court records. Milla, who had lived in Miami for 40 years working in a medical supply business, received the surgery in 2007 at Coral Gables Hospital.

“He didn’t do this to have a bigger penis,” said Aronfeld. “This was because of medical reasons: He just wanted to have relations with his wife.”

But two weeks after the operation, Milla developed an infection that eventually turned to gangrene. Amputation of his penis was necessary to save his life, according to his lawyer, who alleges Boeru didn’t exercise proper care after the surgery.

“Post-operative period is about anywhere between six to 24 hours after surgery. It does not include either days or months,” testified Boeru.

“This is an infection that occurred in this gentleman because he didn’t do what he was supposed to do post-operatively nine days after the surgery,” Boeru’s lawyer Jay Chimpoulis, told WPLG.

He suggested that Milla ignored medical instructions to avoid sex and developed a fecal infection.

“There are any number of ways he could’ve gotten that. None of them had anything to do with [Boeru],” Chimpoulis said.

Dr. Pravin Rao, director of reproductive medicine and surgery at the Johns Hopkins Brady Urological Institute, said penile implants, called prostheses, are safe for patients who are in good health — even those with diabetes, as long as the disease is “controlled.”

The risk rate is lower than 3 percent, according to Rao, who did not treat Milla.

“Usually, it’s the last report option for men who just don’t want to use other treatments as options,” he said. “Sometimes, the individual wants a permanent solution and wants the spontaneity.”

Penile implants are among a “long algorithm of options” for those with erectile dysfunction, according to Rao. Urologists start with pills like Viagra — the least invasive approach –– to vacuum erection devices and injection therapy.

But sometimes those treatments fail because of the quality of the tissue in the penis or poor blood flow.

The most common reason for ED is chronic disease that affects the vessels in the penis — most often diabetes, hypertension, smoking or high cholesterol. Nerve damage, caused by spinal cord injuries, diabetes or radical prostate cancer surgery, can also trigger ED.

A poor candidate for a prosthesis is someone who is not in overall good health and may be at risk under anesthesia or not be able to withstand the blood loss of surgery.

“The number one concern is infection, and that’s why we make sure their overall health and immune status are good and their diabetes is under control,” said Rao.

When infection does occur, the prosthesis must be immediately removed to clear the infection.

“Personally, I have heard of amputation, but not seen one,” said Rao. “We have definitely seen prostheses taken out due to erosion. The wrong size is chosen or there is poor wound healing.”

The prosthesis is an inflatable device that is inserted in the two tubes of the penis. The balloons can be filled up with fluid, creating an erection. A small pump is placed in the scrotum with a reservoir of fluid that connects to the tubing.

“When we first place it, we don’t have it activated to create a full erection,” said Rao. “Then after letting it heal for six weeks, [the patient] comes in and we teach them how to use the pump by squeezing it.”

Patients are told not to have sex during that recuperative period.

Rao said that penile implants are “very successful and infection is not the norm.”

Some studies of patients with diabetes and those without the disease had the same rate of infection. “But,” he said. “We have to be prudent about picking the patient.”

“Prostate surgery for BPH and urinary retention is regarded as a low risk procedure. In my opinion, although a traditional Trans Urethral Resection of the Prostate (TURP) is a safe procedure, it is not as safe as Green Light Laser Vaporization of the Prostate. Using the new Green Light Laser XPS system, I can successfully treat patients with very large prostates traditionally thought only amenable to TURP or Open Prostatectomy. Green Light Laser surgery is safer than TURP in many respects. There is certainly less bleeding, typically no need for overnight hospitalization, no risk for dangerous fluid shifts associated with absorption of glycine used in TURP and decreased length of catheterization. I have not performed a TURP in my urology practice in Miami for over two years now. I cannot comment on the details of the surgery or outcome related to Dick Clark, however, I do think there is virtually no role for a TURP surgery in the modern era where alternatives therapies for enlarged prostate and urinary retention such as Green Light Laser XPS exist. “

The Empowered Patient is a regular feature from CNN Senior Medical News Correspondent Elizabeth Cohen that helps put you in the driver’s seat when it comes to health care.

Hollywood producer and television legend Dick Clark died of a heart attack a day after having prostate surgery, according to a death certificate obtained by CNN.

Clark died last Wednesday at St. John’s Health Center in Santa Monica, California. The day before his death, he had an operation to relieve “acute urinary retention,” an inability to urinate.

“It’s a very painful condition,” says Dr. Kevin McVary, professor of urology at Northwestern University’s Feinberg School of Medicine in Chicago.

The operation is “exceedingly safe” according to McVary, a spokesman with the American Urological Association.

“The mortality rate is less than one in 1,000. That’s very low risk,” he says.

The death certificate lists acute myocardial infarction and coronary artery disease as the causes of death. In December 2004, Clark suffered what was then described as “a mild stroke,” just months after announcing he had been diagnosed with Type 2 diabetes.

Patients with this kind of health history are usually screened by a doctor to test whether their heart is strong enough to withstand surgery, McVary says.

The surgery, known as transurethral resection of the prostate, is considered lower risk because it doesn’t involve an external incision. Instead, doctors insert a surgical tool through the tip of the penis and into the urethra, and then cut away prostate tissue to unblock the flow of urine.

It’s not known why Clark had a heart attack after this procedure. Surgery can be risky for cardiac patients. Anesthesia, for example, can be difficult on the heart, and so can blood pressure fluctuations that occur during surgery.

“Having surgery is a stressful event,” says Dr. Kenneth Rosenfield, an interventional cardiologist at Massachusetts General Hospital in Boston. “It might have been enough to tip him over.”

“Is is low T” is the name of the website and slogan used by Abbott Laboratories to raise awareness regarding low testosterone levels in the aging male. It is a series of questions related to libido, energy, enjoyment and endurance which may be symptomatic of low testosterone levels.

Is it low T, the question raised in their website is a question pondered by many aging males as the experience andropause and notice decreased energy, libido, sexual function and concentration. Low testosterone levels can also result in changes in bone and muscle strength.

Is is low T? Many of our patients are wondering the same thing. At Urological Consultants of Florida, our Miami urologists David Robbins, MD and Amery Wirtshafter, MD are certified experts in the field of urology including the treatment of male andropause and low testosterone. We are available to help you answer the question of Is it low T get you on the path to a clear diagnosis and a treatment program resulting in improved quality of life measures.

]]>https://urologist-miami.com/2012/04/13/is-it-low-t/feed/0drobbinsmdPyeloplasty Surgery Miamihttps://urologist-miami.com/2012/02/29/pyeloplasty-surgery-miami/
https://urologist-miami.com/2012/02/29/pyeloplasty-surgery-miami/#respondWed, 29 Feb 2012 14:55:59 +0000http://urologist-miami.com/?p=167Continue reading →]]>Pyeloplasty surgery is performed to repair a narrowing or stricture at the junction between the kidney and the ureter known as the uretero-pelvic junction or UPJ. A crossing vessel or stricture at the UPJ causes progressive dilatation of the renal pelvis subsequently leading to swelling (hydronephrosis) and worsening renal function or renal failure.

Miami urologist, David Robbins MD is a board certified urologist and recognized leader in da Vinci robotic surgery and expert in robotic pyeloplasty surgery for both stricture disease and crossing vessel at the UPJ (UPJ obstruction). Dr. Robbins trained at New York University and learned to perform robotic pyeloplasty procedures from Dr. Michael Stifelman, internationally acclaimed leader in the field of robotic surgery for the kidney and ureter.

Pyeloplasty procedures using the robotic approach are a minimally invasive option for pyeloplasty performed though four keyhole sized incisions as opposed to a long painful flank incision traditionally used for this surgery. Robotic pyeloplasty procedures are associated with decreased blood loss, less pain and a shorter hospital stay. Miami urologist David Robbins, MD is currently performing robotic pyeloplasty surgery at Mount Sinai Medical Center in Miami Beach as well as Aventura Hospital and Medical Center in Aventura.

“Low testosterone and male andropause has become a hot topic over the past decade. Aging men with symptoms of low sex drive, decreased energy and muscle mass as well as erectile dysfunction are seeking a remedy for their complaints. These symptoms may be secondary to low testosterone. In addition to the symptoms of decreased energy and libido associated with low testosterone, patients may also be at risk for osteoporosis, decreased muscle mass, impaired cognitive ability and concentration, decreased exercise tolerance and even metabolic syndrome and impaired heart health. If you are experiencing any of the above symptoms, please contact us or your current urologist to have your testosterone levels evaluated. Miami urologists David Robbins, MD and Amery Wirtshafter, MD are board certified urologist specializing in the evaluation and treatment of male hypogonadism or testosterone deficiency.

(MayoClinic.com) Hormone changes are a natural part of aging. Unlike the more dramatic reproductive hormone plunge that occurs in women during menopause, however, sex hormone changes in men occur gradually — over a period of many years. Here’s what to expect, and what you can do about it.

Don’t Miss

The term “male menopause” is sometimes used to describe decreasing testosterone levels or a reduction in the bioavailability of testosterone related to aging. Female menopause and so-called male menopause are two different situations, however. In women, ovulation ends and hormone production plummets during a relatively short period of time. In men, hormone production and testosterone bioavailability decline more gradually. The effects — such as changes in sexual function, energy level or mood — tend to be subtle and might go unnoticed for years.

So what’s the best way to refer to so-called male menopause? Many doctors use the term “andropause” to describe aging-related hormone changes in men. Other terms for so-called male menopause include testosterone deficiency, androgen deficiency of the aging male and late-onset hypogonadism.

Understanding male hormones over time

Testosterone levels vary greatly among men. In general, however, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average. By about age 70, the decrease in a man’s testosterone level can be as much as 50 percent.

Recognizing low testosterone levels

Some men have a lower than normal testosterone level without signs or symptoms. For others, low testosterone might cause:

Emotional changes. Low testosterone might contribute to a decrease in motivation or self-confidence. You might feel sad or depressed, or have trouble concentrating or remembering things.

It’s important to note that some of these signs and symptoms are a normal part of aging. Others can be caused by various underlying factors, including medication side effects, thyroid problems, depression and excessive alcohol use. A blood test is the only way to diagnose a low testosterone level or a reduction in the bioavailability of testosterone.

Feeling your best

If you suspect that you have a low testosterone level, consult your doctor. He or she can evaluate possible causes for your signs and symptoms and explain treatment options. You can’t boost your natural testosterone production, but these steps might help:

Be honest with your doctor.Work with your doctor to identify and treat any health issues that might be causing or contributing to your signs and symptoms — from medication side effects to erectile dysfunction and other sexual issues.

Seek help if you feel down.Depression in men doesn’t always mean having the blues. You might have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working excessively, drinking too much alcohol, using illicit drugs or seeking thrills from risky activities.

Be wary of herbal supplements. Herbal supplements haven’t been proved safe and effective for aging-related low testosterone. Some supplements might even be dangerous. Long-term use of DHEA, for example, has no proven benefits and might increase the risk of prostate cancer.

Treating aging-related low testosterone with testosterone replacement therapy is controversial. For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, however — particularly older men — the benefits aren’t clear. The risks are a concern as well. Testosterone replacement therapy might increase the risk of prostate cancer or other health problems. If you wonder whether testosterone injections or other testosterone treatments might be right for you, work with your doctor to weigh the pros and cons.

]]>https://urologist-miami.com/2012/02/22/low-testosterone-treatment-low-sex/feed/0drobbinsmdMayoClinic LogoRadical Prostatectomy Surgery Miamihttps://urologist-miami.com/2012/02/18/radical-prostatectomy-surgery/
https://urologist-miami.com/2012/02/18/radical-prostatectomy-surgery/#respondSat, 18 Feb 2012 23:13:18 +0000http://urologist-miami.com/?p=152Continue reading →]]>“Nerve Sparing Radical Prostatectomy in addition to providing the benefit of improved post operative erectile function for men with localized prostate cancer may improve the ability to achieve normal orgasm. Miami urologist, David Robbins, MD is a regional expert in robotic assisted radical prostatectomy using the da Vinci surgical robot and offers patients the opportunity to have their prostate cancer treated with minimal effect on their quality of life with regard to measures such as erectile function and maintenance of continence. This article shows evidence that nerve sparing prostatectomy may additionally result in improved ability to achieve normal orgasms.” Miami urologist, David Robbins MD

Nerve-Sparing Prostate Surgery Helps Men Retain Sexual Function

Most men left with nerves on both sides of the gland can achieve orgasm, study shows

THURSDAY, Feb. 16 (HealthDay News) — Most men who have surgery for prostate cancer can still achieve orgasm if the nerves that surround their prostate gland are not removed, according to a new study.

Researchers from Cornell University say a man’s age and the number of his nerves that are spared will play a role in his ability to climax after surgery.

The study followed 408 men who underwent a procedure to remove their prostate, known as robot-assisted laparoscopic radical prostatectomy, between 2005 and 2007 for an average of three years. Men had mean age of 60 years and all were able to have an orgasm before the procedure.

Seventy-four percent of the men were able to have their nerves spared bilaterally, or on both sides. Of those men, 91 percent experienced no change in their ability to achieve orgasm following the surgery.

About 13 percent of the men had their nerves spared on only one side. Of this group, 82 percent of the men had the same ability to reach orgasm. Another 12 percent had little or no nerve sparing, with 62 percent of them were still able to achieve orgasm the same way they did before the operation.

The men’s age also played a role in their ability to orgasm. The study, published in the February issue of BJUI, showed orgasm rates were significantly higher in men younger than 60 who had their nerves spared on both sides. Orgasm rates dropped by 10 percent to 83 percent among men older than 60, even if their nerves were spared on both sides.

A questionnaire completed by 156 of the men who were able to achieve orgasm after surgery revealed 82 percent had high satisfaction rates. Another 10 percent said they had moderate satisfaction and 7 percent reported low satisfaction. Roughly 3 percent of the men said they experienced a painful orgasm.

“As far as we are aware, this is the largest analysis of orgasmic function in the robotic prostatectomy literature and will provide valuable information for surgeons talking to patients about what sort of sexual function they can expect after surgery,” study author Dr. Ashutosh Tewari, director of the Prostate Cancer Institute and the LeFrak Robotic Surgery Center at Weill Cornell Medical College, said in a journal news release.

More information

The U.S. National Institutes of Health provides more information on prostate cancer.

]]>https://urologist-miami.com/2012/02/18/radical-prostatectomy-surgery/feed/0drobbinsmdVasectomy Procedure Miami, Floridahttps://urologist-miami.com/2012/02/08/vasectomy-procedure-miami-florida/
https://urologist-miami.com/2012/02/08/vasectomy-procedure-miami-florida/#respondWed, 08 Feb 2012 15:06:30 +0000http://urologist-miami.com/?p=148Continue reading →]]>“Vasectomy procedures are on the rise in Miami and around the country. As the economic slow down progresses, men are seeking a low cost solution to prevent unwanted pregnancies. In our hight volume urology practice in Miami, we have seen a similar upward trend in patients requesting vasectomy procedures. Miami urologists David Robbins, MD and Amery Wirtshafter, MD are available to provide low cost office based minimally invasive vasectomy procedures. Please call our office to schedule an appointment or request further information”

Some urologists around the country are reporting increased numbers of patients coming in for vasectomies.

The schedule for Jones, a Cleveland, Ohio, urologist, has become more crowded during a recent boom in vasectomies.

“My staff came to me and said, what’s happening?” said Jones, the chairman of the Department of Regional Urology of Glickman Urological and Kidney Institute at the Cleveland Clinic. “Why are we suddenly having an explosion in guys asking for vasectomies?”

They looked at their statistics and realized the uptick started around November as the economic crisis deepened. October went down in the history books as one of Wall Street’s worst months.

Since then, the Cleveland Clinic has seen a 50 percent increase in vasectomies, an outpatient surgery that is the cheapest form of permanent birth control. Vasectomies are less invasive and cheaper than tubal ligation, which involves blocking, tying or cutting a woman’s fallopian tubes to prevent pregnancy.

“It’s unlikely that some guy read the Dow Jones numbers that day and said, ‘Why don’t we have a vasectomy?’ ” Jones said. “More likely, people have already been considering it and typically a guy and his wife have spoken a year or two about this.”

Jones was told by patients that they were getting vasectomies because they were losing their jobs and health insurance, or concerned about being out of work soon

“They realize they don’t have the financial security long-term with what’s going on,” Jones said. “Several of them have mentioned, ‘We can’t afford to have any more children in this economy.’ My perception is that it’s more of the concept of raising children in an uncertain economic future.”

Much like Jones, Dr. Marc Goldstein, surgeon-in-chief of male reproductive medicine and surgery at the Cornell Institute for Reproductive Medicine in New York, saw a 48 percent increase in vasectomy consultations compared with the same time last year.

“I have never seen anything like this,” said Goldstein, a urologist for the last 30 years. “When things started to go south in the stock market, then the vasectomy consults went north.”

Half of Goldstein’s New York patients work in the financial sector. New patients filed into his office in November.

“I think the situation of finance and the economy is the major reason,” Goldstein said. “Some of them have mentioned that, ‘It cost $30,000 a year to put my kids in private school and I can’t afford to have another one.’ It’s never the sole reason, but it’s certainly a contributing factor.”

During the vasectomy, the doctor cuts the two vas deferens, which are the tubes carrying sperm from the testicles to become semen. After the procedure, men can still have sex, but their semen does not contain sperm and therefore they can no longer father children.

Doctors can attempt to reverse the procedure, but vasectomy reversals are expensive and only work half the time in restoring sperm flow.

“Some folks will postpone having kids,” he said. “If you had a vasectomy, you’ve made a bigger decision that you’re never going to have another child.”

When people stop having children, it implies a loss of confidence in their future employment prospects.

“Am I going to have a job in six months or a year from now?” Haub said. “If I’m concerned about that, people are not going to increase their financial obligations… It’s naïve to say the economy didn’t play a significant role in lowering the birth rate.”

It’s too early to tell whether this recession has crimped the birth rate, Haub said.

At this point, most of the evidence of increased vasectomies has been anecdotal from practicing urologists, because there is no national registry for sterilizations.

The number of appointment requests spiked 30 percent in January 2009 on the Web site vasectomy.com, which links people with local urologists. But throughout the last few months, appointment requests have been fairly level, said Dr. Ted Benderev, founder of the site.

Dr. Lawrence Ross, a professor of urology at the University of Illinois at Chicago and former president of the American Urological Association, said the school’s clinics have seen moderate increases in the last six months to a year and that vasectomies are growing popular among lower-income clients.

“My guess is that since economic times have worsened, people are concerned about their ability to raise larger families and are opting for more permanent birth control,” Ross said.

People who are concerned about losing their health insurance are trying to take advantage of the coverage for a procedure they’ve long considered.

“It may have something to do with the economy,” said Dr. Bryan Kansas, a urologist. “I can’t count on my hands, in the last three months, the number of times someone has said they’re about to lose their insurance and ask to squeeze them in.”

He and his colleagues have seen a similar uptick in their Austin, Texas, practice called The Urology Team.

Throughout March Madness, Kansas’ office has a special on vasectomies called, “Vas-Madness” to capitalize on their patient’s obsession with the college basketball tournament.

Patients “would love to have a procedure, go home and sit there when you’ve got all-day programming, watch basketball,” Kansas said.

After the lessthan-hourlong procedure, patients usually spend a day or two recovering, moving gingerly and icing the soreness. Some men time their vasectomies around the time of major sports events such as the Masters Golf Tournament and the NCAA basketball tournament to keep themselves entertained during recovery.

Vasectomies are likely to produce tenderness, discomfort and slight swelling and the patient is usually able to return to usual activities within a week.

Green Light Laser Therapy is a minimally invasive surgical option for enlarged prostate (BPH) that combines the effectiveness of the traditional surgical procedure known as transurethral resection of the prostate (TURP), but with less painful recovery, decreased risk for side effects, less bleeding and shorter catheterizations. Miami urologists David Robbins, MD and Amery Wirtshafter, MD routinely perform Green Light Laser procedures.

Green Light Laser therapy to treat enlarged prostate tissue results in a wide open prostate channel for improved urine flow and a quicker return to normal life activities free from bothersome BPH symptoms.

Green Light Laser surgery is typicall performed in an outpatient setting; meaning patients return home within hours of the procedure. After Green Light Laser surgery patients can typically return to normal non-strenuous activities within days. The Green Light Laser system is able to deliver the ultimate treatment for enlarged prostate (BPH) with freedom from bothersome urinary symptoms.

Miami urologists Dr. David Robbins and Dr. Amery Wirtshafter have extensive experience with Green Light Laser surgery for BPH or enlarged prostate and have been providing this service to patients in the Miami region and surrounding areas since Green Light Laser surgery was first introduced.

Greenlight Laser XPS

Miami urologists David Robbins, MD and Amery Wirtshafter, MD are now among a select group of urological surgeons who now offer therapy with the new and improved Green Light Laser XPS sytem which provides improved energy delivery and increased ability to treat patients with very enlarged prostates previously thought not ammenable to minimally invasive surgery.